大骨节病患者寰枢椎脱位的患病率及影像学分析  

Prevalence and radiographic morphology of atlantoaxial dislocation in Kashin-Beck disease

作　　者：吴学元[1] 易智[1] 凌鸣[1] 马宏伟 靳占奎[1] 常彦海[1] 孙正明[1] 刘时璋[1] WU Xueyuan;YI Zhi;LING Ming;MA Hongwei;JIN Zhankui;CHANG Yanhai;SUN Zhengming;LIU Shizhang(Department of Orthopedics,Shaanxi Provincial People’s Hospital,Xi’an 710068;Department of Orthopedics,Ning Xian Second People’s Hospital,Qingyang 745201,China)

机构地区：[1]陕西省人民医院骨科,陕西西安710068 [2]宁县第二人民医院骨一科,甘肃庆阳745201

出　　处：《西安交通大学学报（医学版）》2022年第5期726-731,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省自然科学基础研究计划项目(2019JM-517);陕西省人民医院科技发展孵化基金(2019YXQ-10);陕西省重点研发计划(2018ZDXM-SF-054)。

摘　　要：目的目前对大骨节病(Kashin-Beck disease,KBD)临床及基础研究大都聚焦于畸形明显的四肢骨骼及关节,而对于脊柱尤其是寰枢椎的研究鲜有报道。本研究旨在通过对KBD患者的临床及影像学检查,明确KBD患者寰枢椎脱位(atlantoaxial dislocation,AAD)的患病率及影像学表现。方法观察了111例KBD患者及120例非大骨节病人群一般资料及临床症状,行侧位及过伸、过屈位X线片检查,分析KBD患者的AAD的患病率及影像学表现。KBD组中,通过比较AAD与非AAD患者在年龄、性别、身高、体质量、体质量指数(BMI)、吸烟史、慢性病史及KBD病程、分度等差异,明确KBD发生AAD的相关因素。结果非KBD人群组17.5%(21/120)有神经症状,KBD组中,39.6%(44/111)患者有颈项部疼痛及神经症状,非KBD人群组未检出AAD,KBD组AAD的患病率为16.2%(18/111),两组AAD的患病率差异有统计学意义(χ^(2)=21.10,P<0.001)。影像学检查示,18例AAD中,10例(55.6%)患者伴有齿状突游离,其余8例(44.4%)为齿状突发育不良。根据脱位的方向,12例(66.7%)为前脱位,6例(33.3%)为后脱位;根据是否可具有可复性,16例(88.9%)为可复型脱位,2例(11.1%)为不可复型脱位。与KBD非脱位患者(93例)相比,AAD患者(18例)在年龄、性别、BMI、慢性病比例、吸烟史等方面,差异无统计学意义(均P<0.05);两组患者的身高、体质量、KBD的病程及分度方面,差异均有统计学意义(均P<0.05)。结论KBD可引起齿状突发育不良或游离,导致AAD的发生。本研究可为AAD的筛查、预防及治疗提供临床依据。Objective Until now,most clinical and basic studies on Kashin-Beck disease(KBD)have focused on the visible deformed extremities,and there is a lack of reports concerning their spinal features,especially for the atlantoaxial joint.The purpose of this study was to determine the prevalence and radiographic features of atlantoaxial dislocation(AAD)in KBD in adult patients.Methods The prevalence and radiographic features of AAD were determined by the basic information collected,clinical symptoms,and lateral and dynamic plain radiography in 111 KBD patient and 120 non-KBD participants.In the KBD group,AAD and non-AAD patients were compared in age,gender,height,weight,BMI,smoking history,chronic history,disease duration and grade of disease so as to identify the related factors of the occurrence of AAD.Results Symptoms at the neck or neurological manifestations were present in 17.5%(21/120)in the non-KBD population and 39.6%(44/111)patients with KBD.AAD case was not detected in the non-KBD population,while in 16.2%(18/111)of KBD patients in the endemic area.The prevalence was higher in the KBD patients than in the non-KBD population,and there was a significant difference in the detection rate of AAD between the two groups(χ^(2)=21.10,P<0.001).Plain radiography demonstrated that there were 10(55.6%)cases with separation of the odontoid process and the other 8(44.4%)cases with hypoplasia of odontoid process.Anterior AAD was noted in 12(66.7%)patients and posterior AAD in 6(33.3%)cases based on the displacement direction,while 16(88.9%)cases were reducible and2(11.1%)cases were irreducible on the basis of the reducibility.Comparing the 93 patients with non-AAD KBD patients and18 patients with AAD patients,there was no significant difference in age,sex,BMI,history of medical disease or smoking(all P>0.05).There were significant differences in height,weight,disease duration and grade of disease between AAD and non-AAD patients(all P<0.05).Conclusion KBD can cause the occurrence of atlantoaxial dislocation by inducing separa

关 键 词：大骨节病 寰枢椎脱位 齿状突 影像学形态 

分 类 号：R681.5[医药卫生—骨科学]